Lip Cancer Research Articles

Second Events After Curative-Intent Treatment for Lip Cancer: Navigating the Path of Follow-Up Care.

We aimed to investigate the pattern, risk, and treatment of subsequent events after curative-intent treatment of lip cancer. This retrospective cohort study included 313 patients treated for lip cancer from 2011 to 2021 in a tertiary oncological center. After a median follow-up time of 29.16 months, 145 (46.32%) patients presented with second primary tumors, 93% of which were skin carcinomas. Locoregional recurrence occurred in 7.9% of cases, with 2.5% with nodal recurrence. The 1-, 5-, and 10-year cumulative second primary tumor probabilities were 32.8%, 60.92%, and 70.92%, respectively. A higher risk was observed in elderly patients and basal cell carcinoma cases located on the cutaneous surface of the upper lip. Regional metastasis but not second primary tumors negatively impacted survival. Our study helps fill a literature gap, structuring specific recommendations regarding evaluations and follow-up protocols for patients with lip cancer. Since cutaneous second primary tumors were the most common second event, standard skin examination is key. Age and histology were significant predictors for second primary tumors. For cases of locally advanced lip squamous cell carcinoma, standard guidelines for head and neck cancer must be followed.

Association of Herpes simplex infection with significantly increased risk of head and neck cancer: real-world evidence of about 500,000 patients.

The role of viral agents in the development of head and neck cancers has remained controversial. While markers of viral origin have been isolated from oral cancer tissues, a causative relationship has yet to be shown. The aim of this study was to evaluate the relationship between head and neck cancers and Herpes simplex virus, one of the most common viral infections of the oral orifice. Here, we conducted a retrospective analysis of two age- and gender-matched cohorts extracted from the real-world database TriNetX on March 10th, 2023, each consisting of 249,272 patients with and without Herpes simplex infections (ICD-10: B00). The diagnoses C00-C14 were analyzed, and risk analysis and Kaplan-Meier survival statics were computed. The strongest association was found for lip cancer (ICD-10: C00) with a hazard ratio [HR (CI 95% low-high)] of 3.08 (1.77-5.35). A significant association with HR of 1.17 (1.02-1.34) was found for the entire group of head and neck cancers. Confounders like smoking and alcohol dependence were considered using propensity score matching. The surprisingly strong correlation with lip, oral cavity, and pharynx neoplasms sheds new light on supposedly harmless herpes simplex infections, suggesting them as a possible new factor for risk stratification.

Melatonin and vitamin D as potential synergistic adjuvants for cancer therapy (Review).

Significant advancements have been made in cancer therapy; however, limitations remain with some conventional approaches. Adjuvants are agents used alongside primary treatments to enhance their efficacy and the treatment outcomes of patients. Modern lifestyles contribute to deficiencies in melatonin and vitamin D. Limited sun exposure affects vitamin D synthesis, and artificial light at night suppresses melatonin production. Both melatonin and vitamin D possess anti‑inflammatory, immune‑boosting and anticancer properties, rendering them potential adjuvants of interest. Studies suggest melatonin and vitamin D supplementation may address antioxidant imbalances in lip, oral and pharyngeal cancers. Moreover, promising results from breast, head and neck, brain, and osteosarcoma research indicate potential for tumor growth inhibition, improved survival, and a better quality of life of patients with cancer. The radioprotective properties of melatonin and vitamin D are another exciting area of exploration, potentially enhancing radiotherapy effectiveness while reducing side effects. For its part, the sleep‑promoting effects of melatonin may indirectly benefit patients with cancer by influencing the immune system. Thus, the prevalence of vitamin D and melatonin deficiencies highlights the importance of supplementation, as lower levels can worsen side‑effects from cancer treatments. The present review explores the potential of combining melatonin and vitamin D as synergistic adjuvants for cancer therapy. These agents have shown promise individually in cancer prevention and treatment, and their combined effects warrant investigation. Therefore, large‑scale controlled trials are crucial to definitively determine the optimal dosage, safety and efficacy of this combination in improving the lives of patients with cancer.

High dose rate brachytherapy for lip cancer with interstitial, surface, or a combination of interstitial and surface mold technique

High-dose-rate brachytherapy (HDR-BT) is now becoming more common than low-dose-rate and pulsed-dose-rate BT in the treatment of lip cancer. However, due to the limited history of HDR-BT, relatively few studies have been published. Two institutions (in Ukraine and the USA) reviewed their clinical outcomes of lip cancer patients treated with HDR-BT as monotherapy or in combination with external beam radiotherapy (EBRT). An interstitial (IS), surface custom mold (SC), or a combination of IS and SC (IS+SC) was used for treatments based on the depth of tumor invasion. Prescription doses were 24 Gy in 6 BID fractions when combined with 46-50 Gy of EBRT, 45-55 Gy in 9-10 BID fractions for IS and IS+SC monotherapy or 3 Gy × 16 daily fractions for SC monotherapy. A total of 33 cases of lip cancer were treated from 2015 to 2021. By using TNM staging classification, there were 14 stage I (42.4%), 15 stage II (45.5%), and 4 stage III (12.1%) lip cancers. Thirty-one patients (93.9%) had a complete response to the treatment. Only 2 patients (6.1%) displayed local recurrence. Grade 1, 2, and 3 acute toxicities were observed in 30.3%, 51.5%, and 18.2% of patients, respectively. Grade 1, 2, and 3 late toxicities were observed in 39.4%, 21.2%, and 0.0% of cases. Cosmetic results were excellent in 21.2%, good in 54.5%, fair in 18.2%, and poor in 6.1% of patients. HDR-BT is an effective and safe treatment for lip carcinomas with excellent local control, functional, and cosmetic outcomes and should be considered as a standard treatment.

A comparative study of incidence, mortality and disability adjusted life years (DALYs) for leading cancers in BRICS countries.

While cancer stands as a prominent global contributor to mortality, the BRICS countries, which contribute a considerable proportion of the world's economy, also account for a substantial proportion of global cancer-related deaths. The study aims to compile data on the incidence, mortality and disability-adjusted life years (DALYs) of leading cancers in BRICS countries to assess any variations in these parameters. Indicators such as the age-standardised incidence rate (ASIR) and age-standardised mortality rate (ASMR) were abstracted from GLOBOCAN 2022. Global Burden of Disease 2019 provided an overview of DALYs. Additionally, 'Cancer Tomorrow' provided projections for future cancer rates up to 2050. The findings revealed that Russia had the highest ASIR for both sexes. Among males, leading cancer sites included prostate, lung and colorectum, while India stood out with lip and oral cavity cancer as the primary site. Breast cancer dominated among females in all BRICS countries, except China, where lung cancer took precedence. South Africa recorded the highest ASMR for both sexes, with Russia leading among males and South Africa among females. Lung cancer has been the leading cause of death in all countries except India, where breast cancer leads. Trachea, bronchus and lung cancers contributed the most to DALYs, except in India, where breast cancer prevailed. South Africa and India are anticipated to have the highest increase in new cancer cases and deaths in future. Breast and lung cancers accounted for the highest incidence, mortality and DALYs in females and males, respectively. Although the BRICS countries anticipate sustained economic growth and have viable cancer control plans, it is essential to investigate cancer risk factors and health systems influencing cancer incidence and outcomes.

Epidemiology, Diagnostics, and Therapy of Oral Cancer-Update Review.

Oral cavity and lip cancers are the 16th most common cancer in the world. It is widely known that a lack of public knowledge about precancerous lesions, oral cancer symptoms, and risk factors leads to diagnostic delay and therefore a lower survival rate. Risk factors, which include drinking alcohol, smoking, HPV infection, a pro-inflammatory factor-rich diet, and poor oral hygiene, must be known and avoided by the general population. Regular clinical oral examinations should be enriched in an oral cancer search protocol for the most common symptoms, which are summarized in this review. Moreover, new diagnostic methods, some of which are already available (vital tissue staining, optical imaging, oral cytology, salivary biomarkers, artificial intelligence, colposcopy, and spectroscopy), and newly researched techniques increase the likelihood of stopping the pathological process at a precancerous stage. Well-established oral cancer treatments (surgery, radiotherapy, chemotherapy, and immunotherapy) are continuously being developed using novel technologies, increasing their success rate. Additionally, new techniques are being researched. This review presents a novel glance at oral cancer-its current classification and epidemiology-and will provide new insights into the development of new diagnostic methods and therapies.

Wildfire-related PM2.5 and cause-specific cancer mortality

Wildfires have devastating effects on society and public health. However, little evidence from population-based cohort has been performed to analyze the relationship of wildfire-related PM2.5, an important component of wildfire smoke, with cancer-specific mortality. We aimed to explore this relationship and identify vulnerable populations in UK with lower levels of wildfire-related PM2.5 exposure. The study consisted of 492394 participants (age: 38–73 years) recruited by UK Biobank during 2004–2010. The cumulative wildfire-related PM2.5 within 10 kilometers of residence over three years was used as exposure, which was assessed by chemical transport and machine learning models. A time-varying Cox regression was utilized to explore the relationship of exposure with diverse cancer-specific mortality outcomes. Subgroup analyses of a range of potential modifiers were performed. Each 10 μg/m3 increment of 3-year cumulative exposure was related to a 0.4 % greater risk of total cancer (95 %CI: 1.001–1.007), a 1.1 % greater risk of lung cancer (95 %CI: 1.004–1.018), and a 2.7 % greater risk of lip, oral cavity and pharynx (LOP) cancer (95 %CI: 1.005–1.049). Higher vulnerability in the wildfire-related PM2.5-lung cancer relationship was found among participants being retired than those with other employment status. Even lower levels of exposure to PM2.5 from wildfires were related to elevated mortality risks for cancer from total, lung, LOP, highlighting the importance of wildfire prevention and control. Further investigations are warranted to enrich and extend existing knowledge in this field.

Bauxite mine and alumina refinery workers: mortality and cancer risk.

Aluminium industry workers are at risk of long-term health consequences. To investigate mortality and cancer incidence in bauxite mine and alumina refinery workers. A pre-existing cohort of workers was re-linked with the Australian National Death Index, and the Australian Cancer Database to provide additional death (7 years) and cancer (9 years) data. Standardized mortality ratios (SMRs) and standardized incidence rates (SIRs) were estimated by job category, duration of employment and time since first employment. Linkage was performed for 6935 (6207 male) workers. Compared with the general population, there was a reduced or similar risk of death for mine/refinery workers for all causes except mesothelioma which was increased amongst male production workers [SMR 2.42, 95% CI 1.11-4.60]. Mesothelioma incidence was also increased amongst males [SIR 2.50, 95% CI 1.60-3.71]. Male office workers had a greater incidence of prostate cancer [SIR 1.30, 95% CI 1.06-1.57] and thyroid cancer [SIR 3.47, 95% CI 1.66-6.38]. Melanoma incidence was increased in female office workers [SIR 2.27, 95% CI 1.36-3.54]. Lip cancer incidence was increased in male maintenance/production workers [SIR 2.04, 95% CI 1.02-3.65]. Overall cancer incidence was otherwise similar to the general Australian population. Overall risk of death and incidence of cancer for bauxite mine and alumina refinery workers was similar to the general population. Incidence and risk of death from mesothelioma were higher, likely due to historic asbestos exposure in this and other industries. The increased risk of melanoma, lip, prostate and thyroid cancers requires further investigation.

Clinical outcomes of bilobed platysma myocutaneous flap technique with neck dissection in lower lip squamous cell carcinoma

BackgroundSquamous cell carcinoma (SCC) in the lower lip is among the most frequently encountered types of cancer. As the size of this cancer increases, the need for reconstruction becomes evident, posing a significant challenge. Depending on the staging results in these patients, neck dissection may be recommended. ObjectiveThis study aims to demonstrate the successful application or feasibility of our Bilobed Platysma Myocutaneous Flap technique in patients with lower lip SCC. MethodsThe Bilobed Platysma Myocutaneous Flap was applied to all patients. Following TNM staging, supraomohyoid and/or radical neck dissection were performed. Surveys were conducted with the patients, and scoring was implemented based on the results for evaluation. ResultsBetween 2014 and 2018, 23 patients underwent treatment with this flap, and all flaps survived. Among these patients, bilateral supraomohyoid neck dissection was performed on 14, while modified radical neck dissection on one side and supraomohyoid neck dissection on the other side were conducted on the remaining 9 patients. Throughout the 5-year follow-up period, no recurrence was observed in the patients. ConclusionThe combination of the Bilobed Platysma Myocutaneous Flap technique and neck dissection can be successfully employed in the reconstruction and treatment of lower lip cancers.

An inquiry into patient versus health system factors contribution to the diagnostic interval in oral cancer: an early diagnosis study from Kerala, India.

Lip and oral cavity cancer is the second most frequent cancer in India, accounting for more than 10% of the total cancer incidence in the country. Oral malignancies are frequently found and diagnosed at advanced stages, resulting in dismal survival rates. The influence of healthcare-related factors in the diagnostic interval of oral cancer remains poorly understood. This study followed the principles of the Aarhus statement for early cancer diagnosis research. Researchers non-selectively recruited 261 patients with histopathologically proven Squamous Cell Carcinoma of the oral cavity at the comprehensive Cancer Care Centre in Northern Kerala, India. They acquired information in direct patient interviews using validated instruments. They triangulated self-reported data with case notes, referral letters and biopsy results. The median (Interquartile range) diagnostic interval reported by the study participants (n = 261) was 36.00 (14.00-76.50) days. The proportion of participants having diagnostic intervals of more than 30 days was 57.9% (n = 151). The predictors of diagnostic interval include 'Type of advice provided by the health care provider', Number of healthcare providers consulted in the diagnostic journey, 'Age of the participant', 'Monthly income' and 'Caste'. Nearly three-fifths of the study participants had diagnostic intervals that exceeded the acceptable limit, highlighting the need to streamline the facilities and processes required for early diagnosis of oral cancer. Strengthening the health system at the primary level by incorporating referral guidelines and in-service training of primary care practitioners will reduce diagnostic intervals for oral cancer.

Joseph Pancoast (1805-1882) and His Innovations in Plastic Surgery.

Background: Joseph Pancoast (1805-1882), a prominent figure in 19th-century surgery and medical education, introduced several innovative surgical techniques during his careerPurpose: While he made significant contributions to various areas of surgery, including plastic surgery and anatomy, his techniques were particularly notable for their precision and efficacy.Results: Some of his surgical innovations are the facial grafting especially in rhinoplasty either by using a forehead graft or by using a graft from the cheeks. He introduced his own operation for Staphyloplasty by dissecting two flaps of mucous membrane having a triangular shape and contributed also in taliacotian operation, blepharoplasty, otoplasty, cheiloplastic operation in case of lip cancer, amputations at the hip-joint, ocular deformities and tongue cancer restoration. In ocular surgery he had produced a fine needle turned into a hook in order to be inserted behind the cornea to cut deeply the soft parts of the lens and withdraw any hardened nucleus.

Current advances of oral cancer in Taiwan.

To provide updated statistics of oral cancer incidence and mortality in Taiwan, and to describe recent developments for oral cancer control to reduce oral cancer incidence and mortality. The Taiwan Cancer Registry Annual Report 2023, the Taiwan Cancer Registry Online Interactive Search System, and the 2023 Health Promotion Administration Annual Report are consulted and summarized. A literature search using PubMed was also conducted to identify Taiwan oral cancer control-related studies. Taiwan, with a long history of areca/betel quid chewing, has battled with oral cancer for decades. In 2021, the male lip and oral cavity cancer incidence is 29.77 (per 100,000 persons) and mortality is 11.25. Over these years, the male chewing prevalence was reduced to 6.2% in 2018. Taiwan has a sustained national oral cancer screening programme provided to high-risk groups biennially. Although the age-standardized incidence rates have been slowly decreasing since 2009, due to Taiwan's ageing population, the actual oral cancer burden is still stringent. The collaboration of multi-ministries and agencies on promoting areca nut and betel quid control, improving oral cancer awareness, and delivering cancer care remains essential to prevent oral cancer and reduce oral cancer deaths.

Traversing the Terrain: Potential Pitfalls within the AJCC 8th Edition Staging System for Lip and Oral Cavity Cancers.

In 1977, the American Joint Committee on Cancer (AJCC) introduced the inaugural Cancer Staging Manual, which implemented the T (tumor extent), N (regional lymph node status), and M (presence or absence of distant metastasis) staging system. This systematic approach aimed to convey the extent of disease across various cancer types, providing clinicians with a practical framework to plan treatment strategies, predict prognosis, and assess outcomes. The AJCC 8th edition, effective from January 1, 2018, continues this tradition. However, certain shortcomings persist in the AJCC 8th edition, as identified through clinical experience. Specifically, challenges arise in accurately assessing depth of invasion in unique histological variants of oral squamous cell carcinoma (e.g., Oral verrucous carcinoma, Carcinoma cuniculatum, and Papillary squamous cell carcinoma) and minor salivary gland tumors. Additionally, discrepancies exist in the perception of bone invasion patterns and in reporting practices. There is also a need for staging guidelines for malignant odontogenic tumors and multifocal tumors of the oral cavity, supplemented by diagrammatic representations. Lastly, there is a call for comprehensive staging criteria for carcinomas of the ear, external auditory canal, and temporal bone. We advocate for the inclusion of these considerations in future editions of the AJCC Cancer Staging Manual.

Oral mucosal lesions triage via YOLOv7 models

Background/purposeThe global incidence of lip and oral cavity cancer continues to rise, necessitating improved early detection methods. This study leverages the capabilities of computer vision and deep learning to enhance the early detection and classification of oral mucosal lesions. MethodsA dataset initially consisting of 6903 white-light macroscopic images collected from 2006 to 2013 was expanded to over 50,000 images to train the YOLOv7 deep learning model. Lesions were categorized into three referral grades: benign (green), potentially malignant (yellow), and malignant (red), facilitating efficient triage. ResultsThe YOLOv7 models, particularly the YOLOv7-E6, demonstrated high precision and recall across all lesion categories. The YOLOv7-D6 model excelled at identifying malignant lesions with notable precision, recall, and F1 scores. Enhancements, including the integration of coordinate attention in the YOLOv7-D6-CA model, significantly improved the accuracy of lesion classification. ConclusionThe study underscores the robust comparison of various YOLOv7 model configurations in the classification to triage oral lesions. The overall results highlight the potential of deep learning models to contribute to the early detection of oral cancers, offering valuable tools for both clinical settings and remote screening applications.

Lip and Oral Cancer

Lip and Oral Cancer

Common skin cancers and their association with other non-cutaneous primary malignancies: a review of the literature.

It has long been recognized that a history of skin cancer puts one at risk for additional primary skin cancers. However, more variable data exists for the risk of developing a non-cutaneous primary cancer following a diagnosis of skin cancer. The data are most variable for Basal Cell Carcinoma (BCC), the most common and least aggressive type of skin cancer. While early studies imply that BCC does not impart a larger risk of other primary non-cutaneous cancers, more recent studies with larger populations suggest otherwise. The cancers most significantly associated with BCC are lip, oropharyngeal, and salivary gland cancer. There is also burgeoning evidence to suggest a link between BCC and prostate, breast, and colorectal cancer, but more data are needed to draw a concrete conclusion. Squamous Cell Carcinoma (SCC), the second most common type of skin cancer, has a slightly more defined risk to other non-cutaneous primary malignancies. There is a notable link between SCC and non-Hodgkin's lymphoma (NHL), possibly due to immunosuppression. There is also an increased risk of other cancers derived from squamous epithelium following SCC, including oropharyngeal, lip, and salivary gland cancer. Some studies also suggest an increased risk of respiratory tract cancer following SCC, possibly due to shared risk factors. Melanoma, a more severe type of skin cancer, shows a well-defined risk of additional primary non-cutaneous malignancies. The most significant of these risks include NHL, thyroid cancer, prostate cancer, and breast cancer along with a host of other cancers. Each of these three main skin cancer types has a profile of genetic mutations that have also been linked to non-cutaneous malignancies. In this review, we discuss a selection of these genes to highlight the complex interplay between different tumorigenesis processes.

1556: Interstitial, surface and combined techniques of high dose rate brachytherapy for lip cancer

1556: Interstitial, surface and combined techniques of high dose rate brachytherapy for lip cancer

APPORT DE LA CHIRURGIE PLASTIQUE DANS LES TUMEURS MALIGNES EVOLUEES DES LEVRES

Lip cancers are among the pathologies that are quite common in the practice of plastic surgeons in our country. These tumors in their advanced form provide aesthetic, functional and life-threatening sequelae, which defines their seriousness and the difficulties of management for both oncological excision and reconstruction. The average consultation time was 18 months. The predominant site was located at the level of the lower lip in 53.4%, the macroscopic appearance of the tumors was ulcero-budding in the majority of cases. The repair process was adapted to the location and extent of the defect. Reconstruction involved direct suture in 4.6% of patients, skin grafts in 4.6% of cases, bone graft in 2.3% of cases, locoregional flaps in 72.1%, and bone grafts in 72.1%. remotely in 16.2% of patients.

Precursor Lesions, Overdiagnosis, and Oral Cancer: A Critical Review.

Despite the profession placing great emphasis on oral potentially malignant disorders (OPMDs) as a gateway for early recognition and consequently better outcomes for oral cancer, the death rates for lip and oral cavity cancer have remained stagnant for three decades. Evidence shows that only a small fraction of oral cancers are in fact preceded by OPMDs, and that most OPMDs have an annual transformation rate of less than 1%. As OPMDs encompass a very heterogeneous group of oral conditions, it could be argued that only patients with oral mucosal diseases bearing a substantial risk of malignant transformation warrant close surveillance and treatment, these include proliferative leukoplakia, erythroplakia, non-homogeneous leukoplakia, as well as diseases presenting with severe dysplasia at biopsy. In this narrative review, I discuss the intricate epidemiology of the malignancies that we colloquially refer to as oral cancer, explore the limitations of focusing on OPMDs to reduce the incidence and mortality of oral cavity cancer, and argue that a may-be cancer label represents overdiagnosis for most OPMDs.

A new sliding rotation flap for functional lip reconstruction after cancer ablation: A technical note

ObjectiveTo establish a new technique for ensuring preservation of orbicularis oris muscle continuity and facial nerve for the lip reconstruction after moderate lower lip cancer ablation. MethodsThe surgical procedure consists of three steps. First, a Z-shaped skin flap is created around the nasolabial groove. The incision is made on the skin and muscular side, but not down to the oral mucosa. The angle of the mouth, orbicularis oris muscle, and facial nerve are not affected by this approach. Next, a careful obtuse dissection is performed to preserve the facial artery, facial nerve and mental nerve and to allow freedom of the flap. Finally, changing of the flap allows sliding rotation of the perioral tissue to reconstruct the lip defect. ResultsThe replaced flap pulled new mouth angle outward, and a good morphology was formed. Opening the mouth was sufficiently to wear the dentures. The sphincter movement of the lips was good, and the patient's pronunciation and eating were good. ConclusionThis method may be a useful option for the reconstruction of lower lip after cancer ablation because the resection with safety margins creates a large lip defect.